Testimony
Before the Committee on Government Reform Subcommittee on
National Security, Veterans Affairs and International RelationsUnited States House of RepresentativesCombating
Terrorism - Protecting The United States:
The Role of HHS's Office of Public Health PreparednessStatement ofWilliam F. Raub, Ph.D. Deputy Director,Office of Public
Health Preparedness,
HHS For Release
on Delivery Expected at 1:00
pmon Thursday, March
21, 2002

Good
morning, Mr. Chairman and members of the Subcommittee. I
am William F. Raub, Deputy Director of the Office of Public
Health Preparedness, Department of Health and Human Services
(HHS). I welcome this opportunity to apprise the Subcommittee
about HHS activities related to protecting the United States
from terrorist attacks.

THE
OFFICE OF PUBLIC HEALTH PREPAREDNESS

In
the wake of the terrorist attacks in September and October,
2001, Secretary Thompson acted to strengthen HHS anti-terrorism
programs by creating the Office of Public Health Preparedness
(OPHP) within the Office of the Secretary and recruiting
as its first Director Dr. Donald A. Henderson, an internationally
acclaimed leader in public health. OPHP directs and coordinates
HHS preparedness and response activities related to bioterrorism
and other public health emergencies. The HHS program includes
enhancement of state and local preparedness; development
and maintenance of critical federal government response
assets (such as the National Pharmaceutical Stockpile and
the National Disaster Medical System); research and development
toward new vaccines, diagnostics, and drugs; and liaison
with key organizations outside HHS (such as the White House
Office of Homeland Security and the academic and industrial
communities).

TOPICS
FOR WHICH THE SUBCOMMITTEE REQUESTED COMMENTS

The
Chairman's letter of February 28 to Secretary Thompson listed
six topics to be addressed during this hearing. The remainder
of this statement comprises HHS' comments on those topics.

1. "the extent to which
the Department of Health and Human Services (HHS) coordinates
with, and provides input to the Office of Homeland Defense
in their development of a national strategy to counterterrorism."

HHS
coordinates its anti-terrorism activities closely with the
Office of Homeland Security (OHS). Secretary Thompson and
Dr. Henderson are in frequent contact with OHS Director
Ridge regarding multi-Department activities as well as specific
HHS initiatives. For example, Dr. Henderson recently briefed
OHS staff about HHS awards of more than $1 billion via cooperative
agreements to all 50 States, 4 selected major municipalities
(the District of Columbia, Los Angeles County, Chicago,
and New York City), and the 5 U.S. territories to foster
state and local preparedness for bioterrorism, other outbreaks
of infectious disease, and other public health threats and
emergencies. In addition, the Deputy Director of HHS, Claude
Allen, participates routinely as a member of the Office
of Homeland Security's Deputies Committee, which is the
primary senior-level mechanism for inter-Departmental communication
and coordination. Also, several other HHS senior staff participate
in more specialized inter-Departmental groups, called Policy
Coordinating Committees, that support the work of the Deputies
Committee.

Priorities
for the use of HHS counterterrorism funds are the result
of the confluence of the priorities articulated by the President
in his budget requests and the priorities specified by the
Congress in the regular and supplemental appropriations
for fiscal year 2002. In general, HHS is directing its investments
toward enhanced preparedness for bioterrorism, other outbreaks
of infectious disease, and other public health threats and
emergencies, with anti-bioterrorism enhancements at local,
state, and national levels as job number one.

Guided
by this strategic framework, HHS' primary emphasis areas
are as follows: (a) enhancing state and local preparedness;
(b) improving HHS response assets to support municipalities
and states as needed; (c) developing and procuring safer
and more effective vaccines against smallpox and anthrax;
(d) developing better diagnostic tests, drugs, and vaccines
for the microorganisms most likely to be used by terrorists,
and (e) reinforcing and augmenting border coverage of all
imported products particularly foods through increased inspectional
and laboratory resources and coordination with the U.S.
Customs Service. Within the first category, state and local
preparedness, the HHS focus is on improving the capabilities
of state health departments, local health departments, hospitals,
and Metropolitan Medical Response Systems to respond to
terrorist-related events, including our ability to communicate
at all levels among responders and to the public during
a public health emergency. Within the second category, HHS
response assets, the HHS focus is on improving the infectious
disease surveillance and broader emergency response capabilities
of the Centers for Disease Control and Prevention, augmenting
the size and scope of materials within the National Pharmaceutical
Stockpile and ensuring rapid deployment of these materials
as needed; and on further developing the National Disaster
Medical System.

HHS
is striving for measurable achievements in all these areas.
For example, the recently awarded cooperative agreements
to enhance the terrorism-related capabilities of health
departments and hospitals feature particular "critical benchmarks,"
"critical capacities," and other specific objectives that
the States and other eligible entities are expected to achieve.
In a similar vein, HHS has outlined specific objectives
for its further investments in the National Pharmaceutical
Stockpile, the National Disaster Medical System, and smallpox
vaccine development and acquisition. The Department would
be pleased to provide additional information on these activities
as the Subcommittee may desire.

3.
"agency efforts to coordinate the planning, training, and
consequence management actions among federal, state, and
local agencies"

HHS
has had a longstanding role with respect to the Federal
Response Plan --working
closely with the Federal Emergency Management Agency, the
Department of Justice, and other agencies as appropriate.
In particular, under the Federal Response Plan, HHS is the
lead agency within the federal government for addressing
the medical and public health consequences of all manner
of mass casualty events whether terrorist-induced, accidental,
or naturally occurring. This responsibility is codified
as Emergency Support Function #8.

HHS
is also working to coordinate planning, training, and consequence
management actions at the State and local levels. The recently
awarded cooperative agreements to enhance the terrorism-relevant
capabilities of health departments and hospitals across
the nation emphasize state-wide and regional planning, training
of health professionals and other responders, and medical
and public health preparedness and response to mass casualty
events. As work under the cooperative agreements progresses,
HHS will collaborate with its state and municipal partners
in identifying exemplary practices in these and other preparedness
areas and promoting common approaches wherever appropriate.
For example, in striving to help states and municipalities
strengthen their information technology capabilities, HHS
will place a high priority on achieving interoperability
of communications systems and databases.

4.
"your feedback from the private sector about the role they
will play in addressing the priorities you have identified"

The
private sector seems able and eager to help advance the
HHS priorities. In the vaccine development area, representatives
of the pharmaceutical industry have stressed that, to the
extent that the federal government can prescribe its vaccine
requirements and assure up front that the requisite funds
will be available, the industry will meet the challenge.
Thanks to the President's leadership and Congressional appropriations
for fiscal year 2002, this currently is the case for the
HHS effort to develop and acquire a sufficient quantity
of a new smallpox vaccine to protect the entire U.S. population.
HHS is hopeful for a similar scenario to be realized for
a new anthrax vaccine, if the advanced development work
during fiscal year 2002 is successful and if the President's
request for $250 million for anthrax vaccine acquisition
in fiscal year 2003 is approved by the Congress.

The
private sector also is active in other pertinent areas.
Development of new or improved multi-spectrum antibiotics
is a high priority for the pharmaceutical industry. Many
companies, large and small, are attempting to develop rapid
diagnostic tests and devices for microbes likely to be used
by terrorists. Still other companies, large and small, are
pursuing new information technologies and systems that may
prove valuable for infectious disease surveillance and hospital
response to mass casualty events.

For the purpose of providing
the private sector with a single Department of Health and
Human Services point of contact and maximizing the opportunities
for public private partnerships, Secretary Thompson established
the Council on Private Sector Initiatives to Improve
the Security, Safety, and Quality of Health Care. The
Council is triaging requests from individuals and firms
seeking review of their ideas or products and forwarding
information to the appropriate agencies and offices. This
system ensures that DHHS responds systematically and consistently
to private sector requests.

The
food industry has actively engaged in strengthening security
measures at food processing facilities, restaurants, and
retail establishments through establishment of the Alliance
for Food Security. In January of this year, the Food and
Drug Administration published food security guidance for
the domestic and imported food industries. The guidance
provides a checklist of potential preventive measures that
these firms can take to reduce the risk that food under
their control will be subject to tampering, criminal, or
terrorist action.

5. "other actions to facilitate
the production of new therapeutic medicines and vaccines
against the toxins and agents sought by terrorists"

HHS-funded
research, primarily through the National Institutes of Health,
is attempting to produce new knowledge that will enable
the development of new or improved anti-bioterrorism capabilities.
Foremost among these efforts is the rapidly expanding array
of studies in microbial genomics. By sequencing the genomes
of the various species and strains of the microbes most
likely to be used by terrorists and by performing comparative
analysis of these genomes and their protein products, scientists
hope to achieve fresh leads for the development of new or
improved diagnostic devices, drugs, and vaccines. Moreover,
such research (often referred to as comparative microbial
genomics and proteomics) also may yield new insights into
the genetic basis for why different species of microbes
(or even different strains of the same species) differ from
one another, often substantially, in either their virulence
or their susceptibility to antibiotics. The results of such
research not only could spur advanced development and commercialization
of new diagnostic, therapeutic, and prophylactic products
but also could enable more informed preventative and therapeutic
strategies using existing products.

6.
"additional steps which need immediate attention to protect
United States citizens from terrorist attacks"

HHS
recognizes that much remains to be done to ensure our nation
is adequately prepared for bioterrorism, other outbreaks
of infectious disease, and other public health threats and
emergencies. For example, a robust infrastructure for infectious
disease surveillance will require continuous improvement
over the next several years. Moreover, the development and
commercialization of new diagnostics, drugs, and vaccines
almost inevitably are complex scientific and technical endeavors
and rarely proceed on a predictable course or time line.
Nevertheless, despite these formidable challenges and uncertainties,
HHS believes that its fundamental anti-terrorism strategy
is sound and notes that it is already yielding solid incremental
enhancements in local, state, and national capabilities
to ensure homeland security. The major challenge at present
is to invest in enhanced local, state, and national capabilities
as rapidly yet responsibly as possible. HHS is prepared
to stay the course. Our Nation's security demands nothing
less.